Robot-assisted radical nephroureterectomy for upper urinary tract tumor: initial experience with the use of novel surgical robot system, hinotori

Abstract

Background The hinotori surgical robot system is a promising robotic platform that has been recently introduced into routine clinical practice. The aim of this study was to report our initial experience of robot-assisted radical nephroureterectomy (RANU) using hinotori. Methods This study included a total of eight patients with upper urinary tract tumor (UUTT) who underwent RANU using hinotori via the transperitoneal approach. In this series, nephrectomy was initially performed at the kidney direction stage followed by distal ureterectomy and bladder cuff excision at the bladder direction stage without repositioning of patient or port. Lymphadenectomy was performed at either stage. Results Median age, body mass index, and tumor diameter were 76 years, 21.7 kg/m 2 , and 13 mm, respectively. Of eight patients, three were diagnosed with renal pelvic tumors and five with lower ureteral tumors. They underwent lymphadenectomy targeting the renal hilum plus para-aorta and the pelvis, respectively. All procedures in this series were completed without conversion to open surgery. Median operative time, time using the robotic system, estimated blood loss, and length of hospital stay were 230 minutes, 138 minutes, 23 mL, and 8 days, respectively. No major perioperative complication occurred. Pathological examinations of the tumors revealed seven urothelial carcinomas and one papilloma, the median number of resected lymph nodes was 13, and one patient was positive for both cancer margin and lymph node metastases. Conclusions Despite being a small case series, this is the first study characterizing RANU using the hinotori surgical robot system. RANU was efficaciously and safely performed, resulting in the achievement of favorable perioperative findings.

Evaluation of Clinical Research on Novel Multiport Robotic Platforms for Urological Surgery According to the IDEAL Framework: A Systematic Review of the Literature

“…The remaining 59 studies included in our systematic review were noncomparative surgical series or case reports [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] .…”

“…Eight studies reporting clinical data on Hinotori surgical system were included in our review [19] , [29] , [78] , [79] , [80] , [81] , [82] , [83] ( Table 6 ). The first clinical experience with RAPN was published in 2023 and involved 30 consecutive cases with a median tumour size of 28 mm and a median RENAL nephrometry score of 8 (stage 2b) [78] .…”

“…The study demonstrated equivalent results between the groups in terms of ORT, EBL, warm ischaemia time, complication rates, PSM rates, and renal functional outcomes. The same institution published the first developmental studies on RARN [79] , robot-assisted nephroureterectomy [80] , robot-assisted adrenalectomy [81] , RARN and inferior vena cava thrombectomy [82] , and RARC and intracorporeal urinary diversion [83] with the Hinotori robot. Finally, in 2024 Nakayama et al [29] reported on a nonrandomised study comparing 97 RARPs performed with the Hinotori robot to 40 da Vinci RARP cases that showed overlapping perioperative outcomes.…”

Radical prostatectomy using the Hinotori robot‐assisted surgical system: Docking‐free design may contribute to reduction in postoperative pain

“…In urology, not only robot-assisted radical prostatectomy, but also radical nephrectomy, partial nephrectomy, nephroureterectomy, and adrenalectomy have been performed using the Hinotori system. [2][3][4][5][6] In addition, there have been several reports of robot-assisted surgery using the Hinotori system in gastrointestinal surgery and gynaecology. [7][8][9][10] Furthermore, preclinical research aimed at establishing a telesurgical platform using the Hinotori telesurgical system is also underway.…”

Early experience and future prospects regarding use of newly developed surgical robot system, hinotori, in the field of urologic cancer surgery

“…Since the initial report in 2006 [ 36 ] and the subsequent studies presenting technical refinements [ 37 , 38 ], RANU has been regarded as one of the standard surgical options for patients with upper urinary tract cancer in routine clinical practice, and recent studies have clarified several advantages of RANU over other approaches, including open and laparoscopic surgeries [ 39 , 40 ]. At our institution, following the introduction of RANU using da Vinci Xi, RANU with the use of hinotori was started, and after accumulating experience of RANU using hinotori for eight patients, initial experience of this surgery was reported [ 12 ]. In this series, RANU, including bladder cuff excision and lymph node dissection, was completed in all the eight patients as preoperatively scheduled.…”